Provider Demographics
NPI:1912625500
Name:CABRERA, JOSE MARIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MARIA
Last Name:CABRERA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 RUBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-1049
Mailing Address - Country:US
Mailing Address - Phone:913-485-5403
Mailing Address - Fax:
Practice Address - Street 1:4951 ROE BLVD
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-1109
Practice Address - Country:US
Practice Address - Phone:913-236-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS107172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist